MEDICARE: MR. GREGORY BASHOR MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305006661	VA
2	225100000X	Physical Therapist	7481	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650015833	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8928711	OTHER		AETNA
4	079E3	OTHER	NC	BCBS
5	9251105	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1912969155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY BASHOR MPT

Provider Business Mailing Address
First Line	:	1031 W WILLIAMS ST
Second Line	:	SUITE 103
City	:	APEX
State	:	NC
Zip	:	27502-3955
Country	:	US
Telephone Number	:	919-249-4040
Fax Number	:	919-249-4043

Provider Business Practice Location Address
First Line	:	1031 W WILLIAMS ST
Second Line	:	SUITE 103
City	:	APEX
State	:	NC
Zip	:	27502-3955
Country	:	US
Telephone Number	:	919-249-4040
Fax Number	:	919-249-4043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/30/2008

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Directions to “ MR. GREGORY BASHOR MPT” Practice Location

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